Introduction

Patients with organic gastrointestinal (GI) diseases and diabetes mellitus (DM) can have concomitant symptoms compatible with a disorder of gut-brain interaction (DGBI). The differentiation of symptoms related more to a DGBI than to the organic disease is important since this influences treatment strategies.

Aims & Methods

This study aimed to compare the global prevalence of symptoms compatible with DGBI in adults with and without self-reported organic GI diseases or DM. Data was collected in a population-based internet survey in 26 countries; the Rome Foundation Global Epidemiology Study (N=54,127). Adult subjects were asked if they had ever been diagnosed by a doctor with any of several organic diseases including gastroesophageal reflux disease (GERD), celiac disease (CeD), peptic ulcer, diverticulitis, inflammatory bowel disease (IBD), and DM. Individuals not reporting each respective organic diagnosis were considered as the reference group. DGBI-compatible symptoms were grouped in regional subgroups based on the diagnostic questions of the Rome IV Adult Diagnostic Questionnaire: esophageal, gastroduodenal, bowel, and anorectal with special focus on five of the most frequently reported DGBI in those groups (functional dyspepsia (FD), irritable bowel syndrome (IBS), functional constipation, functional diarrhea and functional abdominal bloating)¹. Mixed logistic regression, with country as random intercept, was used to calculate the odds ratios (ORs, including [95% confidence interval]) of having DGBI-compatible symptoms, comparing every respective organic disease to their reference group.

Results

The total prevalence rates of a self-reported history of organic disease were 13.2% (n=7,148) for GERD, 3.0% (n=1,613) for peptic ulcer, 0.6% (n=323) for CeD, 1.8% (n=993) for IBD, 1.7% (n=902) for diverticulitis, and 7.1% (n=3,884) for DM. Having any organic GI disease of interest increased the odds of symptoms compatible with a DGBI (prevalence 63.4% vs 43.0% in the reference group, OR 2.76 [2.64-2.90]), which was stronger than for DM (48.5% vs 43.0%, OR 1.26 [1.18-1.35]). Among the individual DGBI, symptoms compatible with IBS and FD were most commonly seen in all organic GI diseases. Increased OR for having symptoms compatible with DGBI were seen across the organic GI diseases. Expected strong links between the organic GI disease and DGBI were seen in the corresponding regions for the disease pathology (e.g. IBD and bowel DGBI, GERD and esophageal DGBI), but also with other regions (e.g. IBD and esophageal DGBI, GERD and anorectal DGBI) (Table 1).

Table 1. Prevalence rates as % (95% confidence intervals) of symptoms compatible with DGBI in self-reported organic GI diseases and DM.

Conclusion

DGBI-compatible symptoms are more common in patients with self-reported organic GI diseases and, to lesser extent, DM compared to the general population. Since this difference is also seen between organic disorders and DGBI-compatible symptoms where not expected, this may influence the focus of treatment strategies.

References

1. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021;160(1):99-114.e113.